System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model

Objectives To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. Design A retrospective database analysis. Setting General practices in the UK and Ireland. Participants 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Main outcome measures Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. Results CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the ‘postanalytical test stage’ (n=702, 43.8%), followed closely by ‘communication outcomes issues’ (n=628, 39.1%). Conclusions Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems

Conservative management of oesophageal soft food bolus impaction

Background: Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction. Objectives: To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus. Search methods: We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies. Selection criteria: We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction. Data collection and analysis: We used standard methodological procedures recommended by Cochrane. Main results: We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking. Authors' conclusions: There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published versio

Immunomodulation by vasoactive intestinal peptide is associated with increased survival and growth of Salmonella Typhimurium in mice

© 2019 Elsevier Ltd Studies have shown that administration of vasoactive intestinal peptide (VIP) in mice rescues them from lethal endotoxaemia and that this is correlated with decreased concentration of inflammatory cytokines. VIP has, therefore, been proposed as a novel anti-inflammatory which could be used in the treatment of Gram negative sepsis. However, the effect of VIP has not been reported in mice infected with viable Gram negative bacteria. Here, we show that Salmonella enterica serovar Typhimurium 4/74 significantly increased expression of mRNA of a type 1 receptor (VPAC1) for anti-inflammatory vasoactive intestinal peptide (VIP) in murine ileum and mesenteric lymph nodes at day 6 post-infection (d6 pi) and in the spleen at d3 pi. When VIP (5 nmol/ml) was administered to S. Typhimurium-infected mice, there was a significant increase in the number of S. Typhimurium cultured from murine faeces and ileum at d3 and 6 pi and in MLN and spleen at d3 dpi, compared to faeces and tissues examined from mice infected with S. Typhimurium (without VIP administration). Administration of VIP to S. Typhimurium-infected mice also altered the splenic architecture, resulting in a lack of discernable periarterial lymphoid sheaths or marginal zones at d6 pi but liver histology appeared similar on both d3 and d6 pi. The effects of VIP administration were correlated with a significant decrease in expression of inflammatory cytokine mRNA, associated with systemic inflammatory response syndrome (SIRS) of bacteraemia and acute sepsis. We conclude that VIP inhibits expression of diagnostic/prognostic cytokine biomarkers of sepsis in S. Typhimurium-infected mice. However, this occurred with a concomitant increase in Salmonella growth in tissues and increased bacterial shedding in faeces. Thus, VIP may have potential as an adjunctive therapy to antibiotics in sepsis

Oral vaccination with a rough attenuated mutant of S. Infantis increases post-wean weight gain and prevents clinical signs of salmonellosis in S. Typhimurium challenged pigs

We show that oral inoculation of 14 day old conventional piglets with a rough attenuated Salmonella enterica serovar Infantis 1326/28Фr (serogroup C1), 24 h prior to oral challenge with S. enterica serovar Typhimurium 4/74 (serogroup B), resulted in significant weight gain (~ 10%) measured at 14 days post-weaning (38 days of age). Two days after challenge the S. Typhimurium induced stunting and, in some cases loss, of villi but this was prevented by pre-inoculation with the S. Infantis strain. The clinical signs of disease associated with S. Typhimurium 4/74 challenge and faecal shedding were also significantly (P < 0.05) reduced by pre-inoculation with the S. Infantis mutant. Pre-inoculation of pigs with the S. Infantis mutant also increased weight gain in pigs challenged with pathogenic Escherichia coli. However, Mycobacterium bovis BCG, an unrelated intracellular bacterium, did not protect against challenge with S. Typhimurium 4/74

Oral and Oropharyngeal HPV prevalence in South Africa A systematic review and meta-analysis

Prevalence data for HPV infection in the head and neck in Southern African populations is lacking. In addition to cervical cancer, this sexually transmitted oncogenic virus is responsible for a subset of head and neck cancer and is transmitted via oral sexual routes, and through other forms of intimate contact between anatomical sites lined by mucosa. This systematic review and meta-analyses aimed to synthesize data for the prevalence of head and neck HPV infection in South Africa. Original research papers from South Africa reporting on the prevalence of HPV in the head and neck was systematically reviewed using PubMed, Ovid Medline, Embase and the Cochrane Library. A meta-analysis on the prevalence data wasconducted for 16 papers that met the inclusion criteria

Hawthorn Crater Project Report 1

This project report and presentation outline the research outcomes from the first field study at Hawthorn Ridge Crater at Beaumont Hamel in France. It is co edited by Associate Professor Fiona Graham and Professor John Cassella. Authors include both academic partner Keele University and industry partners including Stoke on Trent City Council, UAV Dynamics, and FARO and analyse the findings relating to the inter disciplinary project including: film, forensic science, history, and archaeology. The crater is one of the largest in France, blown to mark the beginning of the Battle of the Somme on July 1st 1916. Exclusive access has been given to the site for research. The site is of particular significance to film history marking one of the first examples of battlefield film by Geoffrey Malins

A data mining tool for detecting and predicting abnormal behaviour of railway tunnels

The UK railway network is subjected to an electrification process that aims to electrify most of the network by 2020. This upgrade will improve the capacity, reliability and efficiency of the transportation system by providing cleaner, quicker and more comfortable trains. During this process, railway infrastructures, such as tunnels, require to be adapted in order to provide the necessary clearance for the overhead line equipment, and consequently, a rigorous real-time health monitoring programme is needed to assure safety of workforce. Large amounts of data are generated by the real-time monitoring system, and automated data mining tools are then required to process this data accurately and quickly. Particularly, if an unexpected behaviour of the tunnel is identified, decision makers need to know: i) activities at the worksite at the time of movement occurring; ii) the predicted behaviour of the tunnel in the next few hours. In this paper, we propose a data mining method which is able to automatically analyse the database of the real-time recorded displacements of the tunnel by detecting the unexpected tunnel behaviour. The proposed tool, first of all, relies on a step of data pre-processing, which is used to remove the measurement noise, followed by a feature definition and selection process, which aims to identify the unexpected critical behaviours of the tunnel. The most critical behaviours are then analysed by developing a change-point detection method, which detects precisely when the tunnel started to deviate from the predicted safe behaviour. Finally, an Artificial Neural Network (ANN) method is used to predict the future displacements of the tunnel by providing fast information to decision makers that can optimize the working schedule accordingly